Documente Academic
Documente Profesional
Documente Cultură
Infections and
Vesicoureteral
Reflux
in Children
Jake Klein,
MS, CPNP
Clinic Manager
Pediatric Urology Clinic
Childrens Hospital, OU Medical
Center
1)
2)
3)
4)
Prevent
contamination!!!!!
Send urine within 1
hour for accurate
culture results.
Can refrigerate for up
to 24 hrs if delay.
Significant UTIs:
>100,000 CFU/HPF
Vesicoureteral Reflux
Etiology / Pathophysiology
Management Trends / Rx
1)
2)
3)
4)
5)
6)
TREATMENT of VUR
Daily prophylactic antibiotic until reflux selfresolves or is surgically repaired.
Surgery (laparoscopic, open ,DEFLUX)
Aggressive tx of dysfunctional elimination.
ABSOLUTE indication to repair =
Catheterized culture documented
breakthrough UTI.
Several other relative indications to repair
Complications of
VUR Infection
Renal Scarring
Referral
Abnormal antenatal
ultrasounds =
hydronephrosis
Recurrent UTI
Febrile UTIs
VUR lasting 5 years
or longer.
Follow-up
VCUGs/NCGs/RUS
are done yearly.
NRS as indicated if
concerns of scarring
and function loss.
DES patients need
close f/u as indicated.
Prophylactic Medications
Bactrim/Septra/TMP-SMX
Macrodantin, Furadantin,
Nitrofurantoin (1-2
mg/kg/per day) Capsules are
the best.
Keflex
Amoxicillin: (for infants less
than 2 months or allergy to
Bactrim)
Generally dose prophylactics
at 1/3 1/ 4 the therapeutic
treatment dose.
Bactrim
5 kg = tsp
10 kg = tsp
15 kg = tsp
20 kg = 1 tsp
Changes
Minimally invasive
surgery
Observation off RX
Aggressive management
DES
Prenatal detection
Improvements
Early detection
Decreased surgical
morbidity
Pain management
Early hospital discharge
Reduced post-op X-Ray
evaluations.
The END!
References
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Philadelphia, London, New York, St. Louis, Sydney, Toronto: W.B. Saunders Company.
Burns, C.E., Brady, M.A., Dunn, A.M., & Starr,N.B., (2000). Pediatric Primary Care: A hand book
for nurse practitioners (2nd ed.). Philadelphia, London, New York, St. Louis, Sydney, Toronto: W.
B. Saunders Company.
Graham, V.M., Uphold, C.R., (1999). Clinical Guidelines in Child Health (2nd ed.). Gainsville, FL.:
Barmarre Books Inc.
Pearson, L.J., (2000). Nurse Practioners Drug Handbook (3rd ed.). Springhouse, PA.:
Springhouse Corporation
Polin, R.A., Ditmar, M.F., (1997). Pediatric Secrets: Questions you will be asked (2nd ed.).
Philadelphia, PA: Hanley & Belfus, Inc.
Resnick, M.I., Novick, A.C. (2003). Urology Secrets (3 rd ed.). Philadelphia, PA: Hanley & Belfus,
Inc.
Rous, S.N. (1996). Urology: A core textbook (2nd ed.). Cambridge, MS: Blackwell Science, Inc.
Tanagho, E.A., McAnich, J.W. (2004) Smiths General Urology (16th ed.) New York: McGraw Hill.
Walsh, P. C., Retik, A.B., Vaughan, E. D., & Wein, A.J. (2000) Campbells Urology (8th ed.).
Philadelphia, PA : W. B. Saunders Company.
www.q-med.com
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